Mini-Cog量表预测老年髋部骨折术后谵妄风险Predicting the risk of delirium in elderly patients after hip fracture surgery by using Mini-Cog test
刘恒;贾晶丽;吴浩;潘利平;曹永平;李军;刘震宁;叶一林;
摘要(Abstract):
[目的]研究老年髋部骨折患者术后谵妄状态的发生率及相关危险因素。探究Mini-Cog量表评分与谵妄发生的关系。[方法] 70例接受手术治疗的老年髋部骨折患者,收集患者术前血清钠离子浓度、术前牵引制动、术前卧床天数、手术时间、术后3 d血色素下降值、吗啡类药物使用、术后入外科监护室、术后7 d内是否出现谵妄等信息,计算患者Charlson共病指数,进行MMSE量表和Mini-Cog量表评分并记录所用时间。[结果]术后7 d内有28例(40.00%)患者出现谵妄状态。与非谵妄组相比,谵妄组患者术前卧床时间长(P<0.05),术前血清钠离子浓度值低(P<0.05),术后3 d血色素下降多(P<0.05),术前Charlson共病指数高(P<0.05);此外,谵妄组评估术前认知状态的MMSE和Mini-Cog量表评分显著低于非谵妄组(P<0.05)。逻辑回归分析显示:术后谵妄与术前卧床时间、术前血清钠离子浓度、术后3 d血色素下降值、术前Charlson共病指数、术前MMSE量表评分和Mini-Cog量表评分相关。完成Mini-Cog量表时间(3.88±1.67) min,显著低于MMSE量表(12.28±4.84) min (P<0.001)。[结论]老年髋部骨折患者术后谵妄状态的发生与术前卧床时间、术前血清钠离子浓度、术前Charlson共病指数、术前MMSE量表评分和Mini-Cog量表评分相关。评估认知功能障碍的Mini-Cog量表可以简单有效地筛选老年髋部骨折术后谵妄发生的高危患者。
关键词(KeyWords): 老年人;髋部骨折;术后谵妄;Mini-Cog量表
基金项目(Foundation):
作者(Author): 刘恒;贾晶丽;吴浩;潘利平;曹永平;李军;刘震宁;叶一林;
Email:
DOI:
参考文献(References):
- [1]Gleason LJ,Schmitt EM,Kosar CM,et al.Effect of delirium and other major complications after elective surgery in older adults[J].JAMA Surg,2015,150(12):1134-1140.
- [2]Lee KH,Ha YC,Lee YK,et al.Frequency,risk factors,and prognosis of prolonged delirium in elderly patients after hip fracture surgery[J].Clin Orthop,2011,469(9):2612-2620.
- [3]Morrison RS,Magaziner J,Gilbert M,et al.Relationship between pain and opioid analgesics on the development of delirium following hip fracture[J].J Gerontol A Biol Sci Med Sci,2003,58(1):76-81.
- [4]Rudolph JL,Marcantonio ER.Review articles:postoperative delirium:acute change with long-term implications[J].Anesth Analg,2011,112(5):1202-1211.
- [5]Heng M,Eagen CE,Javedan H,et al.Abnormal Mini-Cog is associated with higher risk of complications and delirium in geriatric patients with fracture[J].J Bone Joint Surg Am,2016,98(9):742-750.
- [6]Lee HB,Mears SC,Rosenberg PB,et al.Predisposing factors for postoperative delirium after hip fracture repair in individuals with and without dementia[J].J Am Geriatr Soc,2011,59(12):2306-2313.
- [7]Borson S,Scanlan JM,Chen P,Ganguli M.The Mini-Cog as a screen for dementia:validation in a population-based sample[J].J Am Geriatr Soc,2010,51(10):1451-1454.
- [8]American Psychiatric Association DSM-Task Force Arlington VAUS.Diagnostic and statistical manual of mental disorders:DSM-5?(5th ed.)[J].Codas,2013,25(2):191-192.
- [9]Tombaugh TN,Mcintyre NJ.The mini-mental state examination:a comprehensive review[J].J Am Geriatr Soc,1992,40(9):922-935.
- [10]Borson S,Scanlan J,Brush M,et al.The Mini-Cog:a cognitive‘vital signs’measure for dementia screening in multi-lingual elderly[J].Int J Geriatr Psychiatr,2000,15(11):1021-1027.
- [11]Charlson ME,Pompei P,Ales KL,Mac Kenzie CR.A new method of classifying prognostic comorbidity in longitudinal studies:Development and validation[J].J Chronic Dis,1987,40(5):373-383.
- [12]Fernandez BA,Formiga F,Gomez R.Delirium in hospitalised older persons:Review[J].J Nutr Health Aging,2008,12(4):246-251.
- [13]幸超峰,周明武,李士民,等.老年髋部骨折患者术后谵妄的研究进展[J].实用医药杂志,2013,30(5):467-469.
- [14]Oh ES,Li M,Fafowora TM,et al.Preoperative risk factors for postoperative delirium following hip fracture repair:a systematic review[J].Int J Geriatr Psychiatr,2014,30(9):900.
- [15]Watne LO,Torbergsen AC,Conroy S,et al.The effect of a preand postoperative orthogeriatric service on cognitive function in patients with hip fracture:randomized controlled trial(Oslo Orthogeriatric Trial)[J].BMC Med,2014,12(1):63.
- [16]Tune L,Carr S,Hoag E,et al.Anticholinergic effects of drugs commonly prescribed for the elderly:potential means for assessing risk of delirium[J].Am J Psychiatry,1992,149(10):1393-1394.
- [17]Lundstrom M,Edlund A,Bucht G,et al.Dementia after delirium patients with femoral neck fractures[J].J am Geriatr Soc,2003,51(7):1002-1006.
- [18]Milian M,Leiherr AM,Straten G,et al.The Mini-Cog versus the Mini-Mental State Examination and the Clock Drawing Test in daily clinical practice:screening value in a German Memory Clinic[J].Int Psychogeriatr,2012,24(5):766-774.
- [19]Siempos II,Ntaidou TK,Samonis G.The art of providing resuscitation in greek mythology[J].Anesth Analg,2014,119(6):1336-1341.
- [20]Brox WT,Roberts KC,Taksali S,et al.The american academy of orthopaedic surgeons evidence-based guideline on management of hip fractures in the elderly[J].J Bone Joint Surg Am,2015,97(14):1196-1199.
- [21]Simunovic N,Devereaux PJ,Sprague S,et al.Effect of early surgery after hip fracture on mortality and complications:systematic review and meta-analysis[J].CMAJ,2010,182(15):1609-1616.
- [22]Turnbull AV,Rivier CL.Regulation of the hypothalamic-pituitaryadrenal axis by cytokines:actions and mechanisms of action[J].Physiol Rev,1999,79(1):1-71.
- [23]Trzepacz PT.Delirium.Advances in diagnosis,pathophysiology,and treatment[J].Psychiatr Clin North Am,1996,19(3):429-448.
- [24]Marcantonio ER,Flacker JM,Wright RJ,et al.Reducing delirium after hip fracture:a randomized trial[J].J Am Geriatr Soc,2001,49(5):516-522.